Regulatory Issues
The Centers for Medicare & Medicaid Services (CMS) proposed rules in June that will enable consumers and employers to select hospitals and other healthcare providers in their area based on reports created using patient-protected Medicare data. Public reports on physicians, hospitals and other healthcare providers will combine private-sector claims data with Medicare claims data to identify which hospitals and doctors provide the highest-quality, most cost-effective care.
“Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their healthcare,” says Donald M. Berwick, M.D., CMS administrator. “Making our healthcare system more transparent promotes competition and drives costs down.”
How will the data be gathered and managed and the reporting compiled and released? According to CMS, the program would provide for the following activities:
• CMS would provide standardized extracts of Medicare claims data from Parts A, B and D to qualified entities. The data can only be used to evaluate provider and supplier performance and to generate public reports detailing the results.
• The data provided to the qualified entity will cover one or more specified geographic area(s).
• The qualified entity would pay a fee that covers CMS’ cost of making the data available.
• To receive the Medicare claims data, qualified entities would need to have claims data from other sources. Combining claims data from multiple sources creates a more complete and accurate picture about provider and supplier performance.
• Publicly reporting the results calculated by the qualified entity is important for transparency in healthcare and consumer empowerment. To prevent mistakes, qualified entities must share the reports confidentially with providers and suppliers prior to their public release.
This gives providers and suppliers an opportunity to review the reports and provide necessary corrections.
• Publicly released reports would contain aggregated information only, meaning that no individual patient/beneficiary data would be shared or be available.
• During the application process, qualified entities would need to demonstrate their capabilities to govern the access, use and security of Medicare claims data. Qualified entities would be subject to strict security and privacy processes.
• CMS would continually monitor qualified entities, and entities that do not follow these procedures risk sanctions, including termination from the program.
CMS says that comments are welcome on this set of proposed rules.
